Healthcare Provider Details

I. General information

NPI: 1790127926
Provider Name (Legal Business Name): JOEL KNIGHT CHIROPRACTIC, LLC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 07/30/2013
Last Update Date: 09/24/2018
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

6171 RICHMOND RD
WARSAW VA
22572
US

IV. Provider business mailing address

PO BOX 2388
TAPPAHANNOCK VA
22560-2388
US

V. Phone/Fax

Practice location:
  • Phone: 804-443-6967
  • Fax: 804-443-4938
Mailing address:
  • Phone: 804-333-3269
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code111N00000X
TaxonomyChiropractor
License Number0104557084
License Number StateVA

VIII. Authorized Official

Name: STEVEN F SHIELDS
Title or Position: BILLING MANAGER
Credential:
Phone: 804-282-9133